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Children and Antipsychotics: Medicate or not?

The controversy continues, and goes on… Although I have not been faced with the prospect of medicating Sticks with any sort of antipsychotic medication, the dilemma for parents of ADHDers and whether to take stimulant medications is the same, and as usual, there is much more heat than light being cast on the debate.

This week’s burst of hot light is a bloggy battle of sorts between WebMD’s Dr. Parker and Dr. Flea, another pediatrician blogger that I read.

Because of his extreme symptoms and a positive family history, I had always been suspicious that Billy was manifesting, at an unusually young age, symptoms of Childhood Bipolar Disorder. So, reluctantly, I started Risperdal (one of the newer antipsychotic medications).

His mom described the difference as ‘miraculous’. Billy’s hyperactivity, aggressiveness, and disruptive behaviors became quite manageable.

and asks:

Frankly, I struggle with these questions every time the issue of using psychiatric medications comes up (which is more and more often!). I don’t see any easy, pat answer to the good news/bad news question. For better or for worse, I take it case by case and weigh the pros and cons as best I can.

Anyway, I hope I’ve at least highlighted for you the complexity and importance of what is at stake. This is an issue and a debate only likely to grow in intensity and importance over the next years. Your thoughts?

Finally, Parker pays lip service only to the concern that there may be something wrong with medicalizing complex psychiatric and psycho-social problems:

Are we too quick to default to medications as the first line of treatment? Could this trend reflect an easy way out for a society facing a critical shortage of mental health professionals for children?

For Parker the question is rhetorical and his answer, clearly, is ‘no’. Now that the famous Dr. Parker, the Spock protege, has drunk the Kool-Aid, what hope is there for the rest of us?

Dr. Flea’s comment on Dr. Parker’s entry was also interesting and actually provoked ME much more than his blog entry did:

You chemically tamed this boy, and you made him fat. And you’re pleased with this outcome?

My Response

First, to Dr. Flea:

Before I framed this reply, I searched Dr. Flea’s blog to see if I could discover what his position was on medicating children for ADHD and bipolar disorder. I found no posts on bipolar disorder; 10 on ADHD. Each and every ADHD post that I read revealed a clear anti-medication standpoint, but I saw no constructive ideas for alternatives. Evidently Dr. Flea believes that stimulant medications for ADHD are evil, but hasn’t really presented other options for managing it.

Here’s the problem with that approach: As a parent, we are given the responsibility to feed, clothe, and educate our children. But those are just the basics. Most parents that I know want their kids to grow into successful, happy, productive adults who contribute some small good thing to the world.

When our child is born, we don’t gaze upon them and say to ourselves, “This one is hyper and should be medicated”. We just love them with all our hearts. As time goes by, there are behaviors and patterns that emerge that give us pause and more to the point, begin to gnaw at the child himself. When other children won’t play because he’s too rough, when other parents exclude him from the play dates because he’s loud and won’t stop running around the house hassling everyone, when babysitters and daycare employees ask you politely not to bring him back, there are cues and clues. In our case, Sticks was a very happy, yet very, very hyper child who was confused by the rejection he was experiencing.

The realization that something is wrong dawns over time. I could launch into a litany of all the reasons that ADHD began to hit our radar screen at about age three, but what I’d really like for Dr. Flea to consider is that we brought the problem to our doctor, not the other way around. We went looking for answers to questions that we couldn’t find answers for, and brought concerns that were weighing heavily on us, because it was not just a behavior issue at that point — it was a family issue that threatened Sticks’ self-esteem and mental health as well as our own.

Had we been dismissed out of hand with our concerns, told that he was just being three, told that he would “outgrow” it, we would have had to become hermits, because we were at a point where our entire family was not welcomed — even at some family gatherings.

Honestly, if our pediatrician were as dogmatic as Dr. Flea seems to be, I’d be shopping for a new doctor.

Turning now to Dr. Parker, I see that his patient also brought the problem to him. And rightly so — any child staying awake for 72 hours as a toddler would be a cause for concern! I’m amazed that the single mom had even a shred of sanity left. It seems to me that there was an atmosphere of concern about doing what was right for the child, even if it meant the risky business of trying rather strong medications for him at a very early age.

As a parent, I would be very apprehensive about my child taking antipsychotic medications (as we were when faced with stimulant meds). I think that it also weighs on any doctor who prescribes them.

Dr. Parker asked for thoughts on this issue. I’ve blogged this before, but will reiterate again here. I think it’s important that before these medications are prescribed, the parents know what all of the alternatives are, why they’re being prescribed, what they can expect, and why the doctor feels this is the best option available. I think that they should be prescribed only after the doctor is thoroughly familiar with the child and that the doctor should have experience making such diagnoses. The single mom in Dr. Parker’s case study is fortunate that Dr. Parker has experience with kids who have psychiatric as well as physical problems.

The only thing I would have done differently as a parent would have been to have the diagnosis confirmed by a pediatric psychologist familiar with symptoms of childhood bipolar disorder and/or ADHD. That may not have been an option available to her.

Doctors, as a concerned parent I am asking you to please keep your minds open and all options available. Parents depend on their doctors to understand what steps they need to take medically for their children’s health. Don’t be dogmatic — be open to the possibility that our kids might need these medications.

By the same token, let your decision be guided by your expertise and understanding of the patient, and not what the latest, greatest medication is or an off-the-cuff diagnosis. Much of the backlash that I see toward medicating kids for ADHD comes from the fact that the diagnosis is often made too quickly.

And one final question to anyone reading this — If doctors cannot be supportive of other doctors’ decisions in this regard, how can parents possibly understand what the right thing is?

(ps to Dr. Flea: I highly resent the term “chemically tamed”. My child wasn’t a beast to be tamed and neither is this one)